Monday, November 16, 2015

Deontology and anti-utilitarian promises

Assume deontology. Can one make a promise so strong that one shouldn't break it even if breaking it saves a number of lives? I don't know for sure, but there are cases where such promises would be useful, assuming deontology.

Fred needs emergency eye-surgery. If he doesn't have the surgery this week, he will live, but he will lose sight in one eye. The surgery will be done under general anesthesia, and if Fred is not brought out of the general anesthesia he will die. But there is a complication. A terrorist has announced that if Fred lives out this week, ten random innocent people will die.

Prima facie here are the main options:

Kill Fred. Nine lives on balance are saved.

Do nothing. Fred loses binocular vision, and ten people are killed.

Perform surgery as usual. Fred's full vision is saved, he lives, but ten people are killed.

Deontological constraints rule out (1). Clearly, (3) is preferable to (2). But there is a problem with (3). Once Fred has received general anesthesia, positive actions are needed to bring him out of it. These positive actions will cause the terrorist to kill ten people. Thus, bringing Fred to consciousness requires an application of the Principle of Double Effect: the intended effect is bringing Fred back to consciousness and keeping him from dying; an unintended side-effect is the terrorist's killing of ten. But as it stands, the proportionality condition in Double Effect fails: one should not save one person's life at the expense of ten others. So once Fred has received general anesthesia, Double Effect seems to prohibit bringing him out of it. But this means that there is no morally licit way to do (3), even though this seems the morally best of the unhappy options.

(A legalistic deontologist might try to suggest another option: Perform surgery, but don't bring Fred out of general anesthesia. The thought is that the surgery is morally permissible, and bringing Fred out of general anesthesia will be prohibited, but Fred's death is never intended. It is simply not prevented, and the reason for not preventing it is not in order to save lives, but simply because Double Effect prohibits us from bringing Fred out of general anesthesia. The obvious reason why this sophistical solution fails is that there is no rational justification for the surgery if Fred is't going to be brought back to consciousness. I am reminded of a perhaps mythical Jesuit in the 1960s who would suggest to a married woman with irregular cycles that worked poorly with rhythm--or maybe NFP--that she could go on the Pill to regularize her cycles in order to make rhythm/NFP work better, and that once she did that, she wouldn't need rhythm/NFP any more. That's sophistical in a similar way.)

What we need for cases like this is promises that bind even at the expense of lives. Thus, the anesthesiologist could make such a strong promise to bring Fred back. As a result, Double Effect is not violated in solution (3), because proportionality holds: granted, on balance nine lives are lost, but also a promise is kept.

In practice, I think this is the solution we actually adopt. Maybe we do this through the Hippocratic Oath, or perhaps through an implicit taking on of professional obligations by the anesthesiologist. But it is crucial in cases like the above that such promises bind even in hard cases where lives hang on it.

All that said, the fact that it would be useful to have promises like this does not entail that there are promises like that. Still, it is evidence for it. And here we get an important metametaethical constraint: metaethical theories should be such that the usefulness of moral facts be evidence for them.

7 comments:

Let's suppose that there are such [morally] unbreakable promises, and the anesthesiologist has made such a promise to Fred.Then, the anesthesiologist learns that if she brings Fred back, a nuke will take out the entire city, including Fred, the anesthesiologist, and her family. Alternative 1: a singularity bomb will take out the Earth. Alt 2: A being claiming to be God shows up, shows his god-like powers, and tells the anesthesiologist if she brings Fred back, he will punish her. Alt 2': He says he'll punish her and her family and/or Fred, or some other thing.

Still, here's a promise that is never permissible to break: Bob promises never to torture people for fun. Breaking that promise would always be immoral (but not because it's an instance of breaking a promise).

Very helpful! This is an argument that we shouldn't take the Hippocratic Oath to be such a promise. Rather, such promises need to be tailored to the particular situation.

So there would still be a benefit to the anesthesiologist being able to bindingly promise to bring Fred back notwithstanding the terrorist's original threat. But that promise should be carefully made. Not: "I will bring you back no matter how many lives it costs", but: "I will bring you back notwithstanding this particular terrorist threat."

If an additional threat arises, the anesthesiologist might need to refuse to bring Fred back. My intuitions aren't clear on the numbers, given the special duties of doctors to patients, but I do think that if a new threat comes up, with the anesthesiologist being told that if he brings back Fred then 100 people will die, he shouldn't bring him back. But that's only if that's a new threat. For we could imagine running my original story, but with 100 in place of 10, and we would still have an argument about there being a value to a binding antecedent promise that says: "I will bring you back notwithstanding this threat to 100 people."

(There is also a tricky thing about intentions. I don't think the anesthesiologist can permissibly intend that Fred die, even if she makes this happens by not bringing him back.)

Maybe we can take a doctor in taking on a case to make a commitment to do all that is professionally required notwithstanding those costs that are known to the doctor at the time of taking on the case. Thus, the anesthesiologist commits to bringing Fred back notwithstanding the terrorist threats that she is aware of when she puts Fred under (the ultimate "taking on" of the case), but she doesn't commit to bringing Fred back notwithstanding new information that might come up.

If an additional threat arises, the anesthesiologist might need to refuse to bring Fred back. My intuitions aren't clear on the numbers, given the special duties of doctors to patients, but I do think that if a new threat comes up, with the anesthesiologist being told that if he brings back Fred then 100 people will die, he shouldn't bring him back. But that's only if that's a new threat. For we could imagine running my original story, but with 100 in place of 10, and we would still have an argument about there being a value to a binding antecedent promise that says: "I will bring you back notwithstanding this threat to 100 people." Maybe, but at some (probably fuzzy) point, she is permitted to break the promise (or the promise has an invalid condition, if you prefer). For example, what if the credible threat is the nuke, or the singularity bomb?

(There is also a tricky thing about intentions. I don't think the anesthesiologist can permissibly intend that Fred die, even if she makes this happens by not bringing him back.) Alternative 5: The new threat is that unless the anesthesiologist actually kills Fred by giving him a lethal overdose, then a nuke will kill Fred, the anesthesiologist, and the families of both of them, and destroy the city probably killing over 1 million (if the anesthesiologist fails to kill Fred, that will credibly happen).

Alternative 6: Like 5, but with a singularity bomb.

Alternative 7: Threats by the being claiming to be God and showing god-like powers, etc.

Alternative 8: Specifically, unless she actually kills Fred, then Fred himself will be tortured horribly for days, and then killed...and then the nuke will go off.

Now, 5-8, while interesting, depend on general questions about the extent of deontic prohibitions against intentional killing. I take the strong view that it's wrong to kill an innocent no matter what (barring special permission from God, to whom all life belongs). But such extreme cases are not my interest in this post.

My main interest right now is in cases with this structure: 1. Evil E will occur iff Fred lives. 2. It would be wrong to kill Fred in order to prevent E. 3. Barring special obligations, it would be wrong save Fred's life at the cost of E. 4. It is possible to benefit Fred significantly, but doing so would require him to be temporarily in a position where his life would need to be saved.

The seal of confession is a promise like this (not to reveal the sins that are confessed), and the Church's understanding is that it would bind in all cases without exception (e.g. including the case of the nuke.)

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